SỐT RÉT ẢNH HƯỞNG PHÁT TRIỂN BÀO THAI: BẰNG CHỨNG SIÊU ÂM TRỰC TIẾP ĐẦU TIÊN

Siêu âm phát hiện đường kính trung bình đầu thai nhi nhỏ hơn có ý nghĩa khi thai phụ nhiễm sốt rét trong nửa đầu thai kỳ khi so sánh với thai phụ không bị sốt rét. Bình quân, ở giữa thai kỳ, đường kính đầu thai nhi đo bằng siêu âm nhỏ hơn 2% khi bị sốt rét. Ngay cả đối với người chỉ nhiễm và được điều trị P. falciparum và P. vivax cũng có liên quan đến giảm đường kính đầu thai nhi, bất kể thai phụ có triệu chứng hoặc không.

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Abstract

Background

Intermittent preventive treatment (IPT), the main strategy to prevent malaria and reduce anaemia and low birthweight, focuses on the second half of pregnancy. However, intrauterine growth restriction may occur earlier in pregnancy. The aim of this study was to measure the effects of malaria in the first half of pregnancy by comparing the fetal biparietal diameter (BPD) of infected and uninfected women whose pregnancies had been accurately dated by crown rump length (CRL) before 14 weeks of gestation.

Methodology/Principal Findings

In 3,779 women living on the Thai-Myanmar border who delivered a normal singleton live born baby between 2001–10 and who had gestational age estimated by CRL measurement <14 weeks, the observed and expected BPD z-scores (< 24 weeks) in pregnancies that were (n = 336) and were not (n = 3,443) complicated by malaria between the two scans were compared. The mean (standard deviation) fetal BPD z-scores in women with Plasmodium (P) falciparum and/or P.vivax malaria infections were significantly lower than in non-infected pregnancies; −0.57 (1.13) versus −0.10 (1.17), p < 0.001. Even a single or an asymptomatic malaria episode resulted in a significantly lower z-score. Fetal female sex (p < 0.001) and low body mass index (p = 0.01) were also independently associated with a smaller BPD in multivariate analysis.

Conclusions/Significance

Despite early treatment in all positive women, one or more (a)symptomatic P.falciparum or P.vivax malaria infections in the first half of pregnancy result in a smaller than expected mid-trimester fetal head diameter. Strategies to prevent malaria in pregnancy should include early pregnancy.